| Life Renewing Therapeutic Center, Inc. | |
|
2699 Stirling Rd Fort Lauderdale FL 33312-6517 | |
| (954) 966-3741 | |
| Not Available |
| Full Name | Life Renewing Therapeutic Center, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2699 Stirling Rd, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Laura Marie Kubat (PRESIDENT) |
| Authorized Official Contact | 9543363512 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Renewing Therapeutic Center, Inc. 1401 Sw 66th Ter Plantation FL 33317-5131 Ph: (954) 336-3512 | Life Renewing Therapeutic Center, Inc. 2699 Stirling Rd Fort Lauderdale FL 33312-6517 Ph: (954) 966-3741 |
| NPI Number | 1609169119 |
|---|---|
| Provider Enumeration Date | 05/17/2011 |
| Last Update Date | 05/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609169119 | NPI | - | NPPES |
| 003104400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH7747 (Florida) | Primary |
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